Is Single-Payer The Next To Upset The Status Quo?

The Trump administration proposed a health insurance option for small businesses and the self-employed.

Commentary

For a political junkie like me, this health care debate is fascinating.

Both sides had a whack at the piñata, and came oh so close at busting it open. In 2009, it was the Democrats who were foiled by one of their own when Sen. Joseph Lieberman pulled his support for a public option.

This year, it was Sen. John McCain, R-Ariz., rising from his sick bed to dash Republican dreams of repealing Obamacare with a stunning no vote.

So what now? For that answer, we need to look to the past. While it may seem like health care is lost in the wilderness, the issue is actually following a well-worn path in our shared-power democracy.

I believe that path is leading us to single-payer.

To explain how, we need to look at a couple of trends readily visible whenever Congress attempts to enact a major change to the American way of life.

Both of these trends are at play in the ongoing health care saga.

Trend #1 – The Double Down – Entrenched, fear-of-change lawmakers often find a welcome audience for legislation that affirms an American institution perceived to be “under attack.”

We saw this with the Defense of Marriage Act of 1996 (DOMA), and the Fugitive Slave Act of 1850. Both are examples of failed attempts to arrest a movement to change society.

One reliable consequence of this type of legislation is a boomerang effect that speeds up the change. In effect, it energizes opponents to fight harder. Possibly, it awakens and educates those who are sitting out the issue.

Most recently, we can draw a link between DOMA and the rather quick public polling reversal on same-sex marriage.

I have no doubt that if this Congress manages to pass legislation to undo the Affordable Care Act, it would fuel the same backlash movement.

Trend #2 – The Half Step – Speaking of the ACA, it personifies Trend #2. This is where lawmakers can’t achieve the entire policy change desired, so they settle for what they can get passed.

The half step usually fails, but it gets the ball rolling toward the meaty reform. For example, when the 20th century dawned, tariff reform was the big issue of the day and it buried several politicians. In short, high tariffs greatly benefited manufacturers and farmers, but hurt consumers who paid higher prices.

After many attempts and many failures over decades, President William Taft made tariff reform the centerpiece of his administration. However, the resulting Payne-Aldrich Tariff Act of 1909 pleased almost no one.

But it put the issue in play. Four years later, President Woodrow Wilson and Democrats were able to pass a new income tax that provided income cover for a steep, across-the-board tariff reduction.

Changing Attitudes

Look closer and you’ll see attitudes changing on single-payer. Yesterday, there was this: A majority of doctors nationwide now support a single-payer health care system -- an almost exact reversal of their stance nine years ago.

Fifty-six percent of the 1,033 physicians who responded to the Aug. 3 Merritt Hawkins survey said they either strongly supported or somewhat supported a single-payer system.

That compares with 58 percent of physicians who, in 2008, said they opposed such a system. Back then, only 42 percent supported the concept.

That flip is stunning – or is it? Actually, it’s somewhat similar to the lightning quick reversal on same-sex marriage. In 2008, a Quinnipiac University poll found 55 percent opposed and 36 percent in favor of same-sex marriage. That finding was echoed in many other polls from the time.

Five years later, Quinnipiac repeated the poll and found 56 percent supported and 36 percent opposed same-sex marriage.

Of course, we know how same-sex marriage turned out. Public policy surfed right along with polling data, and by the time the Supreme Court weighed in 2015, same-sex marriage was legal in 36 states and the District of Columbia.

That SCOTUS decision – Obergefell vs. Hodges – ruled that same-sex marriage is guaranteed by the Due Process Clause and the Equal Protection Clause of the 14th Amendment.

Although a monumental decision, it generated little controversy at the time. This is no doubt due to polling that showed support for same-sex marriage hitting 60 percent.

Flawed Legislation

Everyone knows the ACA is flawed. I’m not sure it’s as creaky as some politicians are making it out to be, but fixes are needed.

Ironically, the ACA troubles appear to be pushing public opinion toward single-payer.

A June poll by the Pew Research Center found that 60 percent of respondents say the federal government is responsible for ensuring health care coverage for all Americans.

Isn’t that interesting? But wait, it gets better. One-third of respondents voiced support for single-payer being the vehicle to provide health care. While 33 percent might not seem like a public outcry, that number was 21 percent in a March 2014 Pew poll and 28 percent in January of this year.

We’re entering that critical period where an angry, inflamed voting bloc is going to influence what happens next with health care. They already are influencing votes.

Liberal activism is reportedly through the roof. The 2018 midterm elections will be a huge barometer for how fast single-payer floods into the mainstream policy debate.

In the meantime, those poll numbers will keep climbing.

At some point in the next decade (2020?) the left will control the White House and Congress. And then it’s game over. Maybe they’ll call it the euphemistic “Medicare for all,” but it’ll be single-payer in disguise.

Get ready for it.

InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected].